Citation and License

Arthritis Research & Therapy 2013, 15:R4
doi:10.1186/ar4132

Published: 8 January 2013

Abstract

Introduction

Ultrasonography (US) might have an added value to clinical examination in diagnosing
early rheumatoid arthritis (RA) and assessing remission of RA. We aimed to clarify
the added value of US in RA in these situations performing a systematic review.

Methods

A systematic literature search was performed for RA, US, diagnosis and remission.
Methodological quality was assessed; the wide variability in the design of studies
prohibited pooling of results.

Results

Six papers on the added value of US diagnosing early RA were found, in which at least
bilateral metacarpophalangeal (MCP), wrists and metatarsophalangeal (MTP) joints were
scanned. Compared to clinical examination, US was superior with regard to detecting
synovitis and predicting progression to persistent arthritis or RA. Eleven papers
on assessing remission were identified, in which at least the wrist and the MCP joints
of the dominant hand were scanned. Often US detected inflammation in patients clinically
in remission, irrespective of the remission criteria used. Power Doppler signs of
synovitis predicted X-ray progression and future flare in patients clinically in remission.

Conclusions

US appears to have added value to clinical examination for diagnosing of RA when scanning
at least MCP, wrist and MTP joints, and, when evaluating remission of RA, scanning
at least wrist and MCP joints of the dominant hand. For both purposes primarily power
Doppler US might be used since its results are less equivocal than those of greyscale
US.